According to Cynthia Roat, MPH, a national consultant on language access in healthcare, the two major restrictions hindering the implementation of professional linguistic access programs in hospitals today are:
- Lack of funding and
- Lack of qualified interpreters.
“Fortunately the latter problem is being addressed,” she says. “We have established standards of practice for professional competence, and there are training programs for medical interpreters as well as for clinical staff who use interpreters.”
For example, the National Council on Interpreting in Health Care (NCIHC), a leading advocate of medical interpreting, has developed national standards to improve communication between the LEP patient and the healthcare provider. In addition, many technical and community colleges now offer medical interpreting classes, and some medical schools are beginning to offer seminars and courses designed to train clinical staff to work with interpreters. “Working with interpreters is a concrete, clinical skill,” says Roat.
Still, finding the money for this type of program can have a financial impact on healthcare organizations. Adding to that, accreditation agencies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA) have set compliance standards for language access in terms of its contribution to quality care and patient safety. These compliance standards can also have a financial impact on healthcare organizations.
An even more significant effect may result from the federal government’s mandate to provide language services to LEP individuals. Specifically, Executive Order 13166, “Improving Access to Services for Persons with Limited English Proficiency,” stipulates that hospital and healthcare organizations receiving federal funds are required to provide interpretation services under Title VI of the Civil Rights Act of 1964. Denial of interpreter services to LEP patients is considered a form of discrimination.
In addition, the Office of Minority Health (OMH) within the U.S. Department of Health and Human Services has specified 14 National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) that direct healthcare organizations to make their practices more culturally and linguistically accessible. CLAS standards are organized by themes: Culturally Competent Care, Language Access, and Organizational Support for Cultural Competence. Within this framework, there are three types of obligation: mandates, guidelines, and recommendations. Mandates are current federal requirements for all recipients of federal funds; guidelines are activities recommended by OMH for adoption as mandates by accrediting agencies; and recommendations are standards suggested by OMH for voluntary adoption by healthcare organizations.